Biological grafts: Surgical use and vascular tissue engineering options for peripheral vascular implants

Peripheral arterial occlusive disease is characterized by the reduction of arterial perfusion in the lower extremities. Although advanced pharmacological and endovascular techniques offer a growing therapy option, a surgical bypass of blood vessels on a lower extremity remains the procedure of choice in several patients. When revascularization is recommended, vascular bypass or endarterectomy are the surgical options. Autologous saphenous vein must be preferred for infrainguinal bypass, especially for limb salvage and in the infrapopliteal region. Prosthetic grafts are usually used at selected above-knee levels only when autologous veins are not available. For below-the-knee vascular surgery and small diameter vessel replacement, synthetic grafts are not adequate. In fact, currently available vascular grafts fail due to the thrombogenicity of the artificial surface and intimal hyperplasia. Thus, when autologous grafts are not available, biological substitutes remain the best options. Here, surgical and research strategies are briefly presented.